| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $5 | $168 | $330 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $76 | $189 | $326 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $31 | $108 | $251 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $9 | $161 | $311 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $83 | $98 | $108 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $19 | $100 | $156 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $74 | $152 | $213 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $15 | $166 | $277 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $22 | $227 | $434 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $66 | $211 | $355 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $24 | $173 | $322 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $30 | $167 | $400 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $48 | $255 | $439 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $30 | $278 | $527 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $79 | $110 | $142 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $40 | $103 | $198 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $12 | $26 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $138 | $268 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $47 | $122 | $184 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $19 | $111 | $227 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $112 | $139 | $165 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $93 | $232 | $372 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $22 | $50 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $8 | $17 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $39 | $98 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $39 | $84 | $160 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $69 | $266 | $518 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $10 | $72 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $3 | $7 | $16 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $41 | $98 | $160 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $2,589 | $4,552 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $81 | $152 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,586 | $3,565 | $6,068 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $74 | $185 | $296 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $152 | $657 | $1,162 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $400 | $522 | $643 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $67 | $167 | $268 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $44 | $730 | $1,417 |
| Septoplasty CPT 30520 • ENT | $67 | $1,045 | $2,024 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $39 | $384 | $729 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $36 | $351 | $666 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $50 | $442 | $833 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $65 | $483 | $900 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $159 | $739 | $1,320 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $175 | $334 | $651 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $130 | $588 | $1,047 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $45 | $856 | $1,667 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $19 | $257 | $706 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $270 | $679 | $1,089 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $223 | $545 | $1,131 |